Provider Demographics
NPI:1962754044
Name:SWOFFORD EYE SERVICES, P.C.
Entity type:Organization
Organization Name:SWOFFORD EYE SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:SWOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-932-9656
Mailing Address - Street 1:4420 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3477
Mailing Address - Country:US
Mailing Address - Phone:770-932-9656
Mailing Address - Fax:770-932-6606
Practice Address - Street 1:4420 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3477
Practice Address - Country:US
Practice Address - Phone:770-932-9656
Practice Address - Fax:770-932-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G708730Medicare PIN